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ALL MEMBERS - Plan to join us for the Semi -Annual Meeting of the Northeast Odd Fellows' Association -
Meeting in Dover N.H. February 27th, 2011 Cancelled because of storm
CAMP NEOFA
of the
CAMPER APPLICATION 2011
Ages 8 - 14
All questions MUST be answered and the application signed. PLEASE TYPE OR PRINT.
Name _________________________________________________ Age ____ DOB____ School Grade _____
(Last) (First) (Initial)
Address _________________________________________________________________________________
(Street Number and Name) (Apt. Number)
__________________________________________________ ________________Telephone #____________
(City/Town) (State/Province) (Zip/Postal Code)
Parent/Guardian ________________________________________________ Telephone # ________________
Name/Address of Lodge or
Individual Paying Fee_______________________________________________________________________
Contact Person _________________________________________________ Telephone # ________________
Address _________________________________________________________________________________
*****************************************************************************************
RESERVATIONS
A CAMPING WEEK begins SUNDAY AT NOON, after lunch – ends SATURDAY AT NOON
A fee of $10 per day for early drop off, late pick up, or date change
CAMP NEOFA is open for three (3) weeks
CHECK THE WEEK(S) THE CAMPER WISHES TO ATTEND
FOR 8 – 14 YEAR OLDS
2nd ( ) July 10 - 16 3rd ( ) July 17-23 4th ( ) July 24 - 30
CAMP NEOFA RESERVES THE RIGHT TO REFUSE ANY CHILD WHOSE MEDICAL/BEHAVIORIAL NEEDS CANNOT BE MET
RESIDENTIAL CAMP FEE $275.00 PER WEEK DAY CAMP FEE $125 PER WEEK
A transferable but Non-refundable fee of $75.00 must accompany application
INDIVIDUAL CAMPER FEES MUST BE PAID BY BANK CHECK , MONEY ORDER,VISA OR MASTERCARD
(see reverse side)
HEALTH INFORMATION
Home Physician _______________________________________ Telephone # _____________
Physician’s Address ____________________________________________________________
Name of Insurance Company: ____________________________________________________
Camper’s Insurance/Medicare Number: ____________________________________________
IN THE EVENT OF ACCIDENT OR ILLNESS,
INDIVIDUAL’S INSURANCE WILL TAKE PRIORITY OVER CAMP NEOFA’S INSURANCE
X__________________________________________________________________________
(Parent/Guardian Signature)
PLEASE INCLUDE A COPY OF CAMPER’S MEDICAL CARD WITH APPLICATION
PARENT / GUARDIAN CONSENT
My permission is granted herewith for the attendance of my ( )Son, ( ) Daughter, ( ) Ward, at Camp NEOFA, Montville, Maine. Should any accident or illness befall them, I understand that proper medical attention will be given and if further participation at Camp NEOFA is restricted by the Attending Physician, I am willing that he/she be returned home at my expense. Should he/she be unwilling to cooperate and become irresponsible and/or disruptive, I authorize that he/she be returned home before the session is concluded, at my expense.
IN THE EVENT OF AN EMERGENCY, IF YOU ARE NOT AVAILABLE, PLEASE NOTIFY:
Name ___________________________________________ Relationship: ______________________________
Address __________________________________________________________________________________
Work Phone: ( ) _________________________________ Home Phone: ( )__________________________
Signed Parent/Guardian ______________________________________________Date____________________
Signed Emergency Contact ___________________________________________Date ____________________
Send completed application, holding fee ($75) or registration ($275 OR $125), and copy of camper’s medical card to:
BEFORE JUNE 1: AFTER JUNE 1:
Carla Messer, Director of Camping Carla Messer, Director of Camping
35 Hillside Av PO Box 101
Keene NH 03431 4360 Liberty ME 04949
ADDITIONAL COMMENTS
CAMP NEOFA
of the
MILITARY CAMPER APPLICATION 2011
Ages 8 - 14
All questions MUST be answered and the application signed. PLEASE TYPE OR PRINT.
Name _________________________________________________ Age ____ DOB____ School Grade _____
(Last) (First) (Initial)
Address _________________________________________________________________________________
(Street Number and Name) (Apt. Number)
__________________________________________________ ________________Telephone #____________
(City/Town) (State/Province) (Zip/Postal Code)
Parent/Guardian ________________________________________________ Telephone # ________________
Name/Address of Lodge or
Individual Paying Fee_______________________________________________________________________
Contact Person _________________________________________________ Telephone # ________________
Address _________________________________________________________________________________
J J J J J J J J J J J J J J J J J J J J J J J
RESERVATIONS
A CAMPING WEEK begins SUNDAY AT NOON, after lunch – ends SATURDAY AT NOON
A fee of $10 per day for early drop off, late pick up, or date change
CAMP NEOFA is open for three (3) weeks
CHECK THE WEEK(S) THE CAMPER WISHES TO ATTEND
FOR 8 – 14 YEAR OLDS
2nd ( ) July 10 - 16 3rd ( ) July 17-23 4th ( ) July 24 -30
CAMP NEOFA RESERVES THE RIGHT TO REFUSE ANY CHILD WHOSE MEDICAL/BEHAVIORIAL NEEDS CANNOT BE MET
CAMPER FEE FOR WEEKLY SESSIONS IS $100.00
A transferable but Non-refundable fee of $25.00 must accompany application
INDIVIDUAL CAMPER FEES MUST BE PAID BY BANK CHECK , MONEY ORDER,VISA OR MASTERCARD - #________________________________ Exp. __________
(see reverse side)
HEALTH INFORMATION
Home Physician _______________________________________ Telephone # _____________
Physician’s Address ____________________________________________________________
Name of Insurance Company: ____________________________________________________
Camper’s Insurance/Medicare Number: ____________________________________________
IN THE EVENT OF ACCIDENT OR ILLNESS,
INDIVIDUAL’S INSURANCE WILL TAKE PRIORITY OVER CAMP NEOFA’S INSURANCE
X__________________________________________________________________________
(Parent/Guardian Signature)
PLEASE INCLUDE A COPY OF CAMPER’S MEDICAL CARD WITH APPLICATION
PARENT / GUARDIAN CONSENT
My permission is granted herewith for the attendance of my ( )Son, ( ) Daughter, ( ) Ward, at Camp NEOFA, Montville, Maine. Should any accident or illness befall them, I understand that proper medical attention will be given and if further participation at Camp NEOFA is restricted by the Attending Physician, I am willing that he/she be returned home at my expense. Should he/she be unwilling to cooperate and become irresponsible and/or disruptive, I authorize that he/she be returned home before the session is concluded, at my expense.
IN THE EVENT OF AN EMERGENCY, IF YOU ARE NOT AVAILABLE, PLEASE NOTIFY:
Name ___________________________________________ Relationship: ______________________________
Address __________________________________________________________________________________
Work Phone: ( ) _________________________________ Home Phone: ( )__________________________
Signed Parent/Guardian ______________________________________________Date____________________
Signed Emergency Contact ___________________________________________Date ____________________
Send completed application, holding fee ($25) or registration ($100), and copy of camper’s medical card to:
Carla Messer, Director of Camping
35 Hillside Av
Keene NH 03431 4360
ADDITIONAL COMMENTS
CAMP NEOFA
Owned by the Northeast Odd Fellows Association, Camp NEOFA is located on 35 acres of open fields, woods, and pine groves in Montville, Maine. The camp also features 2,300 feet of water frontage on beautiful Trues’ Pond.
Camp facilities include buildings for sleeping, arts & crafts, recreational activities, dining and a nurse’s station. Outdoor facilities include fields for baseball, soccer and other sports, a pool, volleyball court, and archery area.
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